Provider Demographics
NPI:1427583772
Name:CROSS, SANJIVANI MARIE (LMHC)
Entity type:Individual
Prefix:
First Name:SANJIVANI
Middle Name:MARIE
Last Name:CROSS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SANJIVANI
Other - Middle Name:MARIE
Other - Last Name:SCHRADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5299
Mailing Address - Street 2:MS: 820-5-PCO
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98415-0299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4005 N COOK ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5879
Practice Address - Country:US
Practice Address - Phone:509-530-4230
Practice Address - Fax:509-530-4235
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASCHRASM130DA101Y00000X
WALH61181073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor